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#thebigpush: We Can Halt the Spread of Malaria by 2015

April 25, 2013

Today, April 25th, global citizens worldwide are observing World Malaria Day, energizing their commitment to eradicate the disease. World Malaria Day was instituted by World Health Organization (WHO) Member States during the World Health Assembly of 2007. This annual commemoration highlights the need for continued investment and sustained political commitment for malaria prevention and control. It is also a time for sharing knowledge -- providing countries in affected regions an opportunity to learn from each other's experiences and support each other's efforts; for new donors to join a global partnership against malaria; for research and academic institutions to flag scientific advances to both experts and the general public; and for international partners, companies and foundations to showcase their efforts and reflect on how to further scale up interventions.

Malaria still kills an estimated 660,000 people worldwide...

Over the last decade, the world has made major progress in the fight against malaria. Since 2000, malaria mortality rates have fallen by more than 25%, and 50 of the 99 countries with ongoing transmission are now on track to meet the 2015 World Health Assembly target of reducing incidence rates by more than 75%. A major scale-up of vector control interventions, together with increased access to diagnostic testing and quality-assured treatment, has been key to this progress.

However, much work remains. Malaria still kills an estimated 660,000 people worldwide, mainly children under five years of age in sub-Saharan Africa. Every year, more than 200 million cases occur; most of these cases are never tested or registered. A recent plateauing of international funding has slowed down progress, and emerging drug and insecticide resistance threaten to reverse recent gains.

"Invest in the future: defeat malaria" is the theme partners chose for the next three years to call attention to #thebigpush needed to reach the 2015 Millennium Development Goals and defeat malaria in the future.

WHO will use the 2013 World Malaria Day as an opportunity to illustrate best practices in a range of settings where malaria is a major health challenge, and will facilitate the sharing of experiences between countries to adapt and strengthen malaria control efforts. Each year, Roll Back Malaria (RBM) partner organizations unite around a common World Malaria Day theme. Invest in the future: defeat malaria is the theme partners chose for the next three years to call attention to #thebigpush needed to reach the 2015 Millennium Development Goals and defeat malaria in the future.

Jeffrey D. Sachs, Quetelet Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University, is one of the world's foremost researchers and advocates for the eradication of malaria, HIV/AIDS, and other contributors to extreme poverty. His experience in this arena provides a powerful leadership model for assessing and innovating intervention efforts. Learn more about his experience and approach in the following excerpt from his lecture, Paths to Peace Through Compassion, Cooperation and Sustainable Development, delivered in New York as part of the SGI-USA Culture of Peace Distinguished Speaker Series. The full lecture was published by Culture of Peace Press in Voices for a Culture of Peace Vol.1.

Excerpt from the lecture "Paths to Peace Through Compassion, Cooperation and Sustainable Development"
by Jeffrey D. Sachs

The inability to solve this problem does not rest with our technologies. It lies squarely with us and with our understanding. As I have looked at these shocking realizations, what has amazed me is our incapacity to understand and to act with the power we have.

The beautiful part is that making a difference does not require us to overturn our lives...It just requires our attention, our awareness — nothing more.

I have almost given up on Washington. For a long time, I hoped that someone would sign a check and we would get programs going. I have realized that it is not going to happen that way. I have realized that it is going to happen when we understand the stakes, the opportunities, and when we make direct connections. I have realized that whether it is a global classroom, a temple to a community, a city to a city, or an individual to an individual, we need to turn the tide on a large scale. The beautiful part is that making a difference does not require us to overturn our lives. It does not require self-abnegation to the point of living an ascetic life. It just requires our attention, our awareness — nothing more.

Let me focus on malaria for just a moment because it is the perfect example of a scourge we can end. Malaria is a mosquito-born, tropical disease. The parasite, which is a protozoan, lives in the mosquito and is transmitted to a human when the mosquito bites. That person gets sick, and then another mosquito comes to bite that person and pulls up the parasite and goes on to transmit it to somebody else. This transmission requires warm temperatures, making it a tropical disease. It turns out, for absolutely accidental and fascinating reasons, that in Africa malaria incidence is by far the worst in the world. This is not because Africans are uncaring, corrupt and do not know how to get their act together, but because of the kind of mosquito they have, the high temperatures and the ample mosquito-breeding sites.

[Editor’s Note: Anopheles is a genus of mosquito. Of the approximately 400 anopheles species, 30-40 transmit the Plasmodium parasite that causes malaria. Anopheles mosquitoes usually enter homes between 5:00 p.m. and 9:30 p.m. and again in early hours of morning. They start biting by late evening with the peak of biting activity at midnight and the early hours of morning. By keeping the windows and doors closed between 5:00p.m. and 10:00 p.m. and again in early morning, one can prevent the entry of these mosquitoes into homes. Protection can also be provided by wearing garments that cover the body as much as possible and by using mosquito nets while sleeping.]

There is one type of mosquito(anopheles), that transmits malaria, but there are many kinds of anopheles. As it turns out, Africa has the only kind that does not bite other animals, it only bites humans. Africa’s problem is a burden of nature. It is not the fault of the poor, and it is not to be blamed on the poor.

It is clear that the health problems of the poor have solutions...

One hundred years ago, even ten years ago, we did not have the tools to help. Now, thanks to modern processes, for example making bed nets that protect against mosquitoes, help is here. The bed nets drive mosquitoes out of the hut since they are repelled by the smell. The nets are made in an ingenious way which includes a mosquitocide, and thus it protects the child from being bitten. A company invented a way to put the insecticide right into the resin that is used to weave the net. For five years, when you wash the net, the mosquitocide keeps coming out from the resin and keeps providing a protective cover. If you protect everybody this way, you can drive the malaria burden to zero.

How hard could this be? The nets cost five dollars-- that’s all! Five bucks and they last five years. Do you think we could manage this? We know there are roughly 500 million people in the malaria region of Africa, and that the average size of a household is five people. That’s 100 million households. The average number of sleeping sites in the household is three, so three bed nets are needed for five people. Three bed nets for 100 million households, or 300 million bed nets that cost five dollars equals $1.5 billion.

Here is another denominator. Every minute, the United States spends $1.2 million on the Pentagon. Every day, we spend $1.7 billion on the military. It costs $1.5 billion for five years of bed net coverage versus $1.7 billion per day of military spending! It seems to me that 22 hours of the Pentagon budget would fix this problem. My longstanding policy recommendation is that the Pentagon take next Thursday off. If they did, and we could use the money to give every African family in a malaria zone protection against malaria, our security would be raised profoundly in terms of goodwill, in terms of understanding and in terms of human connection.

Jeffrey Sachs discusses his support for bed nets

It is clear that the health problems of the poor have solutions — like bed nets against malaria. Issues for agricultural productivity also have simple solutions. A while back an agronomist took me, a complete city boy, out to the fields and said, “See the yellow on that maize stalk. It should be green. The yellow is an indication of nitrogen deficiency, because this farmer is too poor to buy a bag of fertilizer.” That’s all.

If you give a 50-kilogram bag of fertilizer to a farmer with half a hectare farm, he can triple his production.

Two hundred years ago, you didn’t need to buy fertillizer. The population was one-tenth the size it is now, and when the soil ran out of nitrogen, you moved to another area. It was called slash-and-burn or rotation agriculture. Now the population in the world is 6.6 billion and the old ways just aren’t an option. But, if you take out the nitrogen, the potassium and the phosphorus, every year, without putting them back, you get massive crop failures.

Farmers in Africa have the yield of about 1 ton per hectare. That is about one third or one quarter of what it should be, and it is not enough to feed the family, much less to have a surplus to take to the market to earn a profit.

Certain things are utterly unimaginable, but true. One of these things is that the World Bank, headquartered in Washington, let African farmers farm for twenty years without fertilizer. Twenty years ago, the World Bank said that the problem of African agriculture is government intervention. They advised that the government get out and let the markets take over. They were wrong. Unfortunately, the market runs away from people who have no money. If you are investing in a business that is specializing in customers who have no money, I suggest you get into another business. The market is not designed to solve the problems of people who have no money.

For twenty years there was no fertilizer. I was a latecomer to this-- what did I know about fertilizer? I am a macroeconomist. I had to learn about malaria. I had to learn about AIDS. I had to learn about fertilizer. The mistake I had been making until then was thinking that someone must be taking care of these problems. The reality is that we were letting people go hungry year in and year out. Then when an extreme famine came, we would ship food from Iowa at about eight times the price it would cost to give a bag of fertilizer in the first place! If you give a 50-kilogram bag of fertilizer to a farmer with half a hectare farm, he can triple his production. This can happen within one season, not years of training and a generation of change, just a bag of fertilizer.

In September 2006, the World Bank issued a report in what is called its Independent Evaluation Office. If I had to paraphrase the 150-page review of their twenty years of agriculture work, the title would be “Sorry,” because the report quite honestly said, “Well, we blew it for twenty years. Nothing we recommended worked. We said the market should get involved but there was no market.”

Let me close by telling you what we have done and mention what you might do.

A few years ago, my colleagues and I worked with Kofi Annan, then U.N. Secretary-General, and we decided that we needed action; we needed to put the policies in place that would save lives. I went knocking on the doors of the White House and 10 Downing Street and other places for help. I explained this to a benefactor, a wonderful trustee of Columbia University, Gerry Lenfest, complaining about the lack of financial support and all the rest, and he said, “Well, what if you actually did this, how much would it cost to help a village?”

I made some quick calculations, and he took out a checkbook. He wrote a $5 million check and said, “Go get it started.”

They know malaria is killing them. They would love bed nets. They just can’t afford them.

We started in Western Kenya, in a place called Sauri Village. One of the most incredible days of my life was meeting with the community in Sauri in the summer of 2004. I recounted it in my book, The End of Poverty. People had walked many kilometers to come, and we sat in the sweltering school hall. I asked them questions. I asked them about malaria. Everybody had it. I asked them, “How many of you have bed nets?” There were two or three hands out of the 250 or so people in the room.

I have heard so many rumors from Washington and elsewhere, all of them wrong, like, “Maybe they don’t like bed nets.” “Maybe they are too hot and they bother people.” I asked this roomful of people: “How many of you know what bed nets are?” I thought that maybe they don’t even know. Every hand went up, of course. I asked, “How many of you would like bed nets?” Every hand stayed up and people got very excited.

A woman in the front row stood up and, through the interpreter, said, “But, Mister, we can’t afford bed nets.”

They are poor, that’s all. They know what bed nets are. They know malaria is killing them. They would love bed nets. They just can’t afford them.

Jeffrey Sachs discusses "The End of Poverty" at the World Bank, Washington, D.C.

We talked about fertilizer the same way and they knew exactly what the situation was. This wasn’t about changing some deep cultural habit somehow, it was just about poverty. I said something about electricity and a man raised his hand, stood up, and said, “Professor, I am chairman of the electricity committee.” Wonderful!-- but there was no electricity anywhere. He explained through an interpreter that they had been told in 1997 that electricity would be coming, so they formed a committee. But electricity never came.

There is nothing that can’t be done in a straightforward fashion, in partnership, to address these problems. We have launched a program that we call Millennium Villages, of which Sauri is one. These are villages committed to meeting the Millennium Development Goals, the goals to fight hunger, poverty and disease by 2015. The Millennium Villages now cover about 600,000 people across Africa.

Millennium Village in Action: Rapid SMS in Sauri, Kenya

Governments, NGOs and companies are all partnering on the Millennium Villages Project. Sometimes companies are vilified, but some of these companies have key technologies that can work towards human betterment. The first company I talked to was Sumitomo Chemical, which makes wonderful bed nets. The chairperson immediately said, “I will provide bed nets for every sleeping site in all of the Millennium Villages for free.” He delivered 360,000 bed nets for free. It didn’t take twenty years to see the results. It took a few days to cover all the sleeping sites. They didn’t go missing, they weren’t stolen, and they didn’t end up in safe deposit boxes. There weren’t bribes. There wasn’t any theft. There were bed nets protecting people from mosquitoes, and the malaria burden went down.

Human-to-human contact is so powerful. It is the essence and the path to peace on the planet.

The point is that there are solutions. They are within our hands. We have no time to lose; our safety depends on it. Our security depends on it.

We can take action. I would like everybody in one way or another to help partner in the cause of meeting the Millennium Development Goals. One way that you can do it is something as straightforward as helping to provide bed nets. There is an organization which I helped to start, called Malaria No More, that can help you do that. The Web address is www.malarianomore.org. It is led by a wonderful philanthropist named Ray Chambers. He is raising tens of millions of dollars for bed nets and helped to get American Idol to Africa last year.

Malaria No More Cameroon: Malaria Music Spotlight, K.O. Palu

Another way is an organization that I co-founded with Mr. Chambers called Millennium Promise, which is devoted entirely to achieving the Millennium Development Goals. Because of the beneficence of wealthy people who support the organization itself, we can say that every cent anybody contributes goes directly to villages. It is used to empower people through a holistic approach, addressing malaria, AIDS and tuberculosis, through a clinic, safe childbirth, safe drinking water, a bag of fertilizer, food supply and microfinance. It is an organization that helps with the transition from subsistence to cash earning, so that communities can escape from poverty once and for all.

I met with heads of state last week in Ethiopia, Mali and in Liberia. The words and the ideas are spreading. President Toure of Mali is an absolutely wonderful person. He has seen the village that we started in Segou, Mali, and asked for more. This past week, we opened the Timbuktu Millennium Village with the most incredible hospitality you can imagine. We are now working with the government on scaling up to 166 communes.

I believe we are capable of ending poverty and to changing the world. I have no doubt that by doing so, we can make the most important connection of all, across every racial divide, religious divide, linguistic divide or any other divide you can think of including class. Human-to-human contact is so powerful. It is the essence and the path to peace on the planet.

If we cannot end now our differences, at least we can help make the world safe for diversity.

Let me end with one statement from that miraculous peace speech by John Kennedy. I find these words to be the most beautiful spoken by any American president of modern times. He said: “So let us not be blind to our differences, but let us also direct attention to our common interests and to the means by which those differences can be resolved. If we cannot end now our differences, at least we can help make the world safe for diversity. For in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air, we all cherish our children’s future, and we are all mortal.”

John F. Kennedy, Commencement Address at American University, June 10, 1963 - Part 1

John F. Kennedy, Commencement Address at American University, June 10, 1963 - Part 2

John F. Kennedy, Commencement Address at American University, June 10, 1963 - Part 3

Jeffrey D. Sachs is widely considered to be the leading international economic advisor of his generation. For more than twenty years, he has been in the forefront of the challenges of economic development, poverty alleviation and enlightened globalization, promoting policies to help all parts of the world benefit from expanding economic opportunities and well-being. He is also one of the leading voices for combining economic development with environmental sustainability, and as Director of the Earth Institute leads large-scale efforts to promote the mitigation of human-induced climate change.

Dr. Sachs is also Quetelet Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University as well as Special Advisor to United Nations Secretary-General Ban Ki-moon. From 2002 to 2006, he was Director of the U.N. Millennium Project and Special Advisor to U.N. Secretary-General Kofi Annan on the Millennium Development Goals, the internationally agreed goals to reduce extreme poverty, disease and hunger by 2015. Dr. Sachs is also president and co-founder of Millennium Promise Alliance, a nonprofit organization aimed at ending extreme global poverty.

In 2004 and 2005, he was named among the hundred most influential leaders in the world by Time magazine. In 2007, he was awarded the Padma Bhushan, a high civilian honor bestowed by the Indian government. Sachs lectures constantly around the world and was the 2007 BBC Reith Lecturer. He is author of hundreds of scholarly articles and many books, including New York Times best sellers The End of Poverty (Penguin, 2005) and Common Wealth (Penguin, 2008). Sachs is a member of the Institute of Medicine and is a research associate of the National Bureau of Economic Research. Prior to joining Columbia University, he spent more than twenty years at Harvard University, most recently as Director of the Center for International Development. A native of Detroit, Michigan, Sachs received his B.A., M.A., and Ph.D. degrees at Harvard University. His work supports several of the eight action areas identified by the United Nations Programme of Action on a Culture of Peace, especially the third: Promoting sustainable economic and social development.